SECTION 260.113. Mandatory Participation Requirements of an Individual

An individual or LAR must comply with the following mandatory participation requirements:

(1) completing and submitting an application for Medicaid financial eligibility to HHSC in accordance with §260.61(h)(2) of this subchapter (relating to Process for Enrollment of an Individual) or within another time frame permitted by §260.61(i) of this subchapter if the individual does not have Medicaid financial eligibility;

(2) participating on the service planning team to:

(A) develop an enrollment IPP, as described in §260.65 of this chapter (relating to Development of an Enrollment IPP);

(B) develop a proposed enrollment IPC, as described in §260.67 of this subchapter (relating to Development of a Proposed Enrollment IPC); and

(C) review and revise the IPP and IPC, as described in §260.77 of this subchapter (relating to Renewal and Revision of an IPP and IPC);

(3) reviewing, agreeing to, signing, and dating an IPP and IPC;

(4) utilizing natural supports and other non-waiver and non-CFC services and supports for which the individual may be eligible before accessing DBMD Program services and CFC services;

(5) cooperating with the program provider in the delivery of DBMD Program services and CFC services listed on the individual's IPC, including:

(A) working with the program provider to schedule meetings;

(B) attending a scheduled meeting with the case manager or a service provider;

(C) being available to receive DBMD Program services and CFC services;

(D) notifying the program provider in advance if the individual or LAR is unable to keep an appointment or is unavailable to receive services in the individual's residence; and

(E) admitting program provider representatives to the individual's residence for a scheduled meeting or to receive DBMD Program services and CFC services;

(6) cooperating with the program provider's service providers to ensure progress toward achieving the goals and outcomes described in the IPP;

(7) if found by HHSC to be financially eligible for DBMD Program services based on the special institutional income limit, paying the required co-payment in a timely manner;

(8) notifying the program provider if the individual receives notice from HHSC of a change in the status of the individual's financial eligibility for Medicaid;

(9) not engaging in criminal behavior in the presence of a service provider or, if the individual receives licensed assisted living or licensed home health assisted living, another individual residing in the same residence;

(10) not permitting a person present in the individual's residence to engage in criminal behavior in the presence of a service provider or, if the individual receives licensed assisted living or licensed home health assisted living, another individual residing in the same residence;

(11) not acting in a manner that is threatening to the health and safety of a service provider or, if the individual receives licensed assisted living or licensed home health assisted living, another individual residing in the same residence;

(12) not permitting a person present in the individual's residence to act in a manner that is threatening to the health and safety of the case manager or a service provider or, if the individual receives licensed assisted living or licensed home health assisted living, of another individual residing in the same residence;

(13) not exhibiting behavior or permitting a person present in the individual's residence to exhibit behavior that places the health and safety of a service provider in immediate jeopardy;

(14) not initiating or participating in fraudulent health care practices;

(15) not engaging in behavior that endangers the individual's health or safety;

(16) not permitting a person present in the individual's residence to engage in behavior that endangers the individual's health or safety; and

(17) paying room and board on time if the individual receives licensed assisted living.

Source Note: The provisions of this §260.113 adopted to be effective February 26, 2023, 48 TexReg 896